Cancer Follow-up Research Articles

Loss to Follow-up in Head and Neck Cancer: A Systematic Review of Randomized Controlled Trials.

To evaluate the reporting and rates of loss to follow-up (LTFU) in head and neck cancer (HNC) randomized controlled trials based in the United States. Pubmed/MEDLINE, Cochrane, Scopus databases. A systematic review of titles in Pubmed/MEDLINE, Scopus, and Cochrane Library was performed. Inclusion criteria were US-based randomized controlled trials focused on the diagnosis, treatment, or prevention of HNC. Retrospective analyses and pilot studies were excluded. The mean age, patients randomized, publication details, trial sites, funding, and LTFU data were recorded. Reporting of participants through each stage of the trial was documented. Binary logistic regression was performed to evaluate associations between study characteristics and reporting LTFU. A total of 3255 titles were reviewed. Of these, 128 studies met the inclusion criteria for analysis. A total of 22,016 patients were randomized. The mean age of participants was 58.6 years. Overall, 35 studies (27.3%) reported LTFU, and the mean LTFU rate was 4.37%. With the exception of 2statistical outliers, study characteristics including publication year, number of trial sites, journal discipline, funding source, and intervention type did not predict the odds of reporting LTFU. Compared to 95% of trials reporting participants at eligibility and 100% reporting randomization, only 47% and 57% reported on withdrawal and details of the analysis, respectively. The majority of clinical trials in HNC in the United States do not report LTFU, which inhibits the evaluation of attrition bias that may impact the interpretation of significant findings. Standardized reporting is needed to evaluate the generalizability of trial results to clinical practice.

ASSOCIATION BETWEEN TWENTY SERUM MIRNAS AND CLINICOPATHOLOGICAL VARIABLES IN PATIENTS WITH BREAST CANCER

Determining that miRNAs play a role in breast cancer pathogenesis suggests that it may be useful in the diagnosis and treatment of breast cancer. In this study, 39 patients with invasive breast cancer were diagnosed with serum levels of 20 miRNAs(miR-105, miR-21, miR-141, miR-200a, miR-200b, miR-200c, miR-203, miR-210, miR-375, miR-34a, miR-133a, miR-155, miR-139-5p, miR-143, miR-145, miR-365, miR-299-5p, miR-411, miR-452, miR-17) were analyzed during diagnosis and after treatment. In the analysis results, it is detected that serum levels of miR-200c(p=0.030), miR-375(p=0.045), miR-34a(p=0.042) were significantly higher in the local advanced/metastatic group. Serum level of miR-141(p=0.062) was lower in patients with positive lymph node involvement, whereas miR-133a(p=0.037) levels were higher in the same patient group. MiR-105(p=0.015), miR-203(p=0.015), miR-375(p=0.033), miR-145(p=0.025) serum levels were significantly higher in the progesterone receptor negative group, likewise miR-105(p=0.053) levels were high in the estrogen receptor negative patient group. The high levels of miR-375 and miR-133a were noticeable in human epidermal growth factor receptor-2 positive patients(p=0.037 and p=0.014, respectively). MiR-143(p=0.009) and miR-145(p=0.017) levels were observed to be higher in the patient group with a ki-67 index>20%. It was found that 2 miRNAs(miR-133a(p=0.018) and miR-139-5p(p=0.004)) were significantly higher in patients in the luminal B group, which were separated by molecular subgroups. Nine of miRNAs that evaluated(miR-105(p=0.0001), miR-21(p=0.001), miR-141(p=0.041), miR-200a(p=0.003), miR-200b(p=0.0001), miR-200c(p=0.0001), miR-203(p=0.0001), miR-34a(p=0.0001), miR-452(p=0.018)) significantly increased after treatment and 5 of the miRNAs(miR-155(p=0.0001), miR-143(p=0.0001), miR-145(p=0.0001), miR-365(p=0.0001), miR-299-5p(p=0.0001)) were significantly reduced after treatment. We think that miRNAs may help in evaluating the follow-up and prognosis of invasive breast cancer.

Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States.

The annual direct medical cost attributable to human papillomavirus (HPV) in the United States over the period 2004-2007 was estimated at $9.36 billion in 2012 (updated to 2020 dollars). The purpose of this report was to update that estimate to account for the impact of HPV vaccination on HPV-attributable disease, reductions in the frequency of cervical cancer screening, and new data on the cost per case of treating HPV-attributable cancers. Based primarily on data from the literature, we estimated the annual direct medical cost burden as the sum of the costs of cervical cancer screening and follow-up and the cost of treating HPV-attributable cancers, anogenital warts, and recurrent respiratory papillomatosis (RRP). We estimated the total direct medical cost of HPV to be $9.01 billion annually over the period 2014-2018 (2020 U.S. dollars). Of this total cost, 55.0% was for routine cervical cancer screening and follow-up, 43.8% was for treatment of HPV-attributable cancer, and less than 2% was for treating anogenital warts and RRP. Although our updated estimate of the direct medical cost of HPV is slightly lower than the previous estimate, it would have been substantially lower had we not incorporated more recent, higher cancer treatment costs.

Abstract P2-20-08: Expression of ACVRL1 in a subset of recruited tumor-associated macrophages drives resistance to PD-1 therapy in human breast cancer

Abstract The activin-like kinase receptor 1 (ALK1, encoded by ACVRL1) is a member of the transforming growth factor β (TGF-β) superfamily. Expression of ALK1 has been historically associated with endothelial cells, thus serving as a potential target for antiangiogenic therapy in cancer. Despite promising preclinical results with a ligand trap (RAP-041/dalantercept), clinical trials did not show additional benefit of dalantercept when combined or contrasted with the standard of care. This outcome raises the question about patient selection and optimal combination partner in the clinical setting. Moreover, from the biological perspective, how ALK1 signaling shapes the features of a tumor is still largely uncharted. Based on our previous observations, we confirmed that the genetic network correlated with ACVRL1 expression is associated with immune processes in human breast cancer. Next, we validated that inhibition of ALK1 altered the immune landscape in experimental primary breast cancer (MMTV-PyMT model), providing a rationale for a combined regimen with immunotherapy. After developing and validating a murine model of adjuvant therapy with RAP-041 (syngeneic E0771 and 4T1 cell lines), we discovered that ALK1 blockade potentiated immune checkpoint inhibitors. Based on bulk RNA-sequencing and a multicolor FACS approach, addition of RAP-041 to immunotherapy significantly reduced the number of intratumoral macrophages compared with either treatment alone. Notably, these changes were coupled with systemic alterations in peripheral blood cell composition, with the combined administration suppressing circulating monocytes. Interestingly, ALK1 signaling appears to be a pivotal contributor to this phenotype, as fewer circulating monocytes were also detected in the RAP-041 cohort. Based on our in vitro characterization, we revealed that ALK1 expression is not limited to endothelial cells, as different myeloid populations readily expressed Acvrl1, suggesting a direct functional role of ALK1. Stimulation of ALK1 did not alter macrophage polarization, even though different levels of mediators downstream of ALK1 characterized the M1/M2 states. Furthermore, apoptosis and necrosis did not seem to be affected upon activation of ALK1, while the effect on the cell cycle awaits confirmation. In vitro genetic modulation of ALK1 activity is ongoing, with co-culture systems, transendothelial adhesion and migration being currently assessed. Inspection of several human sc-RNA-sequencing datasets confirmed the existence of ACVRL1-positive monocytes in human PBMCs from healthy individuals as well as in human solid cancers, including breast cancer. Focusing on the immune compartment, ACVRL1 expression characterized recruited tumor-associated macrophages (TAMs) and their cycling counterpart. In light of this feature, longitudinal follow-up of patients exposed to chemotherapy and/or anti-PD-1/PD-L1 revealed that expression of ACVRL1 decreased following exposure to chemotherapy. Notably, high ACVRL1 expression and an increased proportion of ACVRL1-positive TAMs were found at progression with anti-PD-1 treatment. In agreement with our preclinical data, ACVRL1-positive cells were depleted from circulation upon recurrence, indicating a migration from blood to tumors. Finally, survival analysis determined that ACVRL1hi signature in macrophages correlated with a significantly lower survival in a 5-year follow-up in breast cancer. In conclusion, our work sheds light on the value of ALK1 as a promising dual antiangiogenic and immunomodulatory target for precision medicine in cancer. Citation Format: Mehrnaz Safaee Talkhoncheh, Jonas Sjölund, Paulina Bolivar Balbas, Ewa Kurzejamska, Sara Larsson, Eugenia Cordero, Clara R. Oudenaarden, Jessica Pantaleo, Göran Jonsson, Charlotte Rolny, Matteo Bocci, Kristian Pietras. Expression of ACVRL1 in a subset of recruited tumor-associated macrophages drives resistance to PD-1 therapy in human breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-20-08.

Treatment burden in survivors of prostate and colorectal cancers: a qualitative interview study

ObjectivesTreatment burden is the workload of healthcare and the impact this has on the individual. Treatment burden is associated with poorer patient outcomes in several chronic diseases. Illness burden has...

Isolated pulmonary langerhans cell histiocytosis: A diagnostic challenge in oncologic patients.

Isolated pulmonary langerhans cell histiocytosis: A diagnostic challenge in oncologic patients.

Abstract P4-07-17: Follow-up in breast cancer care: guidelines and individual risks

Abstract The aim of this study was to investigate how breast cancer follow-up in the Netherlands changed during the COVID-19 pandemic, compared to 2018-2019, and to what extent follow-up during the pandemic corresponded to the patient risk of recurrence. During the early phase of the pandemic the Dutch Society for Surgical Oncology (NVCO) issued a report with recommendations on how follow-up could be postponed, as a guidance for the pandemic, based on a low, intermediate or high risk of recurrence. In this study we investigated to what extent this advice was followed. A dataset of 33160 women diagnosed with primary invasive breast cancer between January of 2017 and July of 2021 was selected from the Netherlands Cancer Registry (NCR) and Dutch Hospital Data (DHD). The pandemic, 2020 and weeks 1-32 of 2021, was divided into six periods (A to F), based on the number of hospitalized COVID patients in the Netherlands. The five-year risk of locoregional recurrence (LRR) was determined for each patient with the INFLUENCE nomogram. The LRR risk was compared to the risk groups from the NVCO report with a Kruskal-Wallis test. The percentage of patients who received a mammogram during period A to F was compared to the same periods of 2018-2019 with a chi-squared test. Correlation between the LRR risk, and if patients had a mammogram, was investigated with logistic regression. This analysis was repeated separately for the risk groups. Correlation between the LRR risk, and time intervals between surgery and the first and second mammogram was analyzed using cox proportional hazard models, this was also repeated for the risk groups. There was a significant difference in LRR risk between the NVCO risk groups. In the low-risk group (n=7673), 86 patients (1.1%) had a risk >5%. In the intermediate risk group (n=19197), 18364 patients (95.7%) had a risk of < 5%, and 65 patients (0.34%) had a risk of >10%. In the high-risk group (n=2674), 2365 patients (88.4%) had a risk < 10%. The percentage of patients who received a mammogram was significantly lower in periods B to F of the pandemic. Logistic regression showed a negative correlation between the risk of LRR and if patients had a mammogram in 2020 (OR 0.93) and 2021 (OR 0.93). There was also a negative correlation between the risk groups and mammography in 2020 (OR 0.92 for intermediate and 0.80 for high), and for the risk groups and mammography in 2021 (OR 0.98 for intermediate and 0.95 for high). There was no significant impact of LRR risk, or risk group, on time intervals between mammograms. During the pandemic, patients with a higher LRR risk, or a higher risk according to NVCO advice, had lower odds of having a mammogram. If the advice would have been followed, in 0.5% of the patients scheduled for follow-up, the recommendation was to postpone in contrast to a high estimation of the individual risk. For 62.7%, a follow-up was recommended, despite a low estimated individuals risk. Because the number of high-risk patients is relatively low, individual risk prediction could be supportive, in case of future restrictions. This way the high-risk patients can be identified and prioritized for follow-up, and can also be encouraged to come to the hospital. Citation Format: Lotte Van Dongen, Joyce Meijer, Jolanda Van Hoeve, Desiree van den Bongard, Marielle Hendriks, Aafke Honkoop, Luc Strobbe, Cristina Guerrero Paez, Sabine Siesling. Follow-up in breast cancer care: guidelines and individual risks [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-17.

Characteristics of patient navigation programs in the Cancer Moonshot ACCSIS colorectal cancer screening initiative.

Although patient navigation has shown promise for increasing participation in colorectal cancer screening and follow-up, little evidence is available to guide implementation of patient navigation in clinical practice. We characterize 8 patient navigation programs being implemented as part of multi-component interventions of the National Cancer Institute's Cancer Moonshot Accelerating Colorectal Cancer Screening and Follow-Up Through Implementation Science (ACCSIS) initiative. We developed a data collection template organized by ACCSIS framework domains. The template was populated by a representative from each of the 8 ACCSIS research projects. We report standardized descriptions of 1) the socio-ecological context in which the navigation program was being conducted, 2) navigation program characteristics, 3) activities undertaken to facilitate program implementation (eg, training), and 4) outcomes used in program evaluation. ACCSIS patient navigation programs varied broadly in their socio-ecological context and settings, the populations they served, and how they were implemented in practice. Six research projects adapted and implemented evidence-based patient navigation programs; the remaining projects developed new programs. Five projects began navigation when patients were due for initial colorectal cancer screening; 3 projects began navigation later in the screening process, when patients were due for follow-up colonoscopy after an abnormal stool-test result. Seven projects relied on existing clinical staff to deliver the navigation; 1 hired a centralized research navigator. All project researchers plan to evaluate the effectiveness and implementation of their programs. Our detailed program descriptions may facilitate cross-project comparisons and guide future implementation and evaluation of patient navigation programs in clinical practice.

Patient experience of follow-up after surgery for kidney cancer: a focus group study.

To explore patient experience of follow-up care after kidney cancer surgery and to develop recommendations for best practice. We conducted two focus groups, including 14 participants with experience of kidney cancer follow-up after surgery, to elicit patient views on current follow-up care. Thematic analysis was used to identify unifying themes to describe the patient experience of follow-up, and the results were then used to develop a set of recommendations for best practice. We identified six themes (feelings of abandonment; uncertainty about the plan; anxiety about appointments; variation in care; a need for information; and a need for emotional support) that described current patient experience and areas in which current care could be improved. In particular, while most of the participants felt that their physical needs had been met, many had struggled with unmet emotional needs and a lack of information and resources. This was especially noted in the period immediately following surgery, when feelings of abandonment were common, and around follow-up scans and routine appointments, which were a source of anxiety. Our participants also described concerns about the lack of consistency between different hospitals and centres around the United Kingdom, with differences in the content and quality of follow-up care. Based on the results, we developed a list of recommendations to address some of the challenges described through relatively minor changes to the care pathway. We identified gaps and variability in current follow-up care after kidney cancer surgery, and have developed a set of recommendations that, if implemented, would improve the follow-up care experience for these patients.

Risk Stratified Follow-Up for Endometrial Cancer: The Clinicians' Perspective.

Risk-stratified follow-up for endometrial cancer (EC) is being introduced in many cancer centres; however, there appears to be diversity in the structure and availability of schemes across the UK. This study aimed to investigate clinicians' and clinical specialist nurses' (CNS) experiences of follow-up schemes for EC, including patient-initiated follow-up (PIFU), telephone follow-up (TFU) and clinician-led hospital follow-up (HFU). A mixed-methods study was conducted, consisting of an online questionnaire to CNSs, an audience survey of participants attending a national "Personalising Endometrial Cancer Follow-up" educational meeting, and qualitative semi-structured telephone interviews with clinicians involved in the follow-up of EC. Thematic analysis identified three main themes to describe clinicians' views: appropriate patient selection; changing from HFU to PIFU schemes; and the future of EC follow-up schemes. Many participants reported that the COVID-19 pandemic impacted EC follow-up by accelerating the transition to PIFU/TFU. Overall, there was increasing support for non-HFU schemes for patients who have completed primary treatment of EC; however, barriers were identified for non-English-speaking patients and those who had communication challenges. Given the good long-term outcome associated with EC, greater focus is needed to develop resources to support patients post-treatment and individualise follow-up according to patients' personal needs and preferences.

Trends in oncological imaging during the COVID-19 pandemic through the vaccination era.

This study examines the impact that the COVID-19 pandemic has had on computed tomography (CT)-based oncologic imaging utilization. We retrospectively analyzed cancer-related CT scans during four time periods: pre-COVID (1/5/20-3/14/20), COVID peak (3/15/20-5/2/20), post-COVID peak (5/3/20-12/19/20), and vaccination period (12/20/20-10/30/21). We analyzed CTs by imaging indication, setting, and hospital type. Using percentage decrease computation and Student's t-test, we calculated the change in mean number of weekly cancer-related CTs for all periods compared to the baseline pre-COVID period. This study was performed at a single academic medical center and three affiliated hospitals. During the COVID peak, mean CTs decreased (-43.0%, p < 0.001), with CTs for (1) cancer screening, (2) initial workup, (3) cancer follow-up, and (4) scheduled surveillance of previously treated cancer dropping by 81.8%, 56.3%, 31.7%, and 45.8%, respectively (p < 0.001). During the post-COVID peak period, cancer screenings and initial workup CTs did not return to prepandemic imaging volumes (-11.4%, p=0.028; -20.9%, p=0.024). The ED saw increases in weekly CTs compared to prepandemic levels (+31.9%, p=0.008), driven by increases in cancer follow-up CTs (+56.3%, p < 0.001). In the vaccination period, cancer screening CTs did not recover to baseline (-13.5%, p=0.002) and initial cancer workup CTs doubled (+100.0%, p < 0.001). The ED experienced increased cancer-related CTs (+75.9%, p < 0.001), driven by cancer follow-up CTs (+143.2%, p < 0.001) and initial workups (+46.9%, p=0.007). The pandemic continues to impact cancer care. We observed significant declines in cancer screening CTs through the end of 2021. Concurrently, we observed a 2× increase in initial cancer workup CTs and a 2.4× increase in cancer follow-up CTs in the ED during the vaccination period, suggesting a boom of new cancers and more cancer examinations associated with emergency level acute care.

Correlation of Clinician- and Patient-Reported Outcomes in the BC2001 Trial

AimsTo evaluate whether there is sufficient correlation between patient-reported outcomes (PROs) and clinician-reported outcomes (CROs) in bladder cancer follow-up post-radiotherapy to streamline data collection and to reduce trial follow-up burden on patients, clinicians and trial programmes. Materials and methodsPROs data were collected within the BC2001 trial using the Functional Assessment of Cancer Therapy specific to bladder cancer (FACT-BL) questionnaire. CROs data were collected by clinicians using Late Effects in Normal Tissues Subjective, Objective and Management (LENT/SOM). Data were collected at baseline, post-treatment, at 6 and 12 months post-randomisation and then annually to 5 years. The percentage agreement between CROs and PROs measures was evaluated at 2 and 5 years post-randomisation. Concordance was tested using the weighted Kappa statistic with 95% confidence intervals. ResultsCorrelation was evaluated between six categories of the FACT-BL and LENT/SOM scores. At 2 years the percentage agreement across these domains ranged from 45 to 78%, with the weighted Kappa statistic between 0.07 and 0.35. Results were similar in year 5 with 48–83% agreement and kappa statistics between –0.02 and 0.21. ConclusionThe correlation between CROs and PROs in patients treated with radiotherapy for bladder cancer were generally poor. PROs appear to be more sensitive, with higher grade events reported. Further work is needed to evaluate whether PROs alone can be used to evaluate toxicity-related outcomes in randomised controlled trials.

Data Challenges in Identifying Patients Due for Colorectal Cancer Screening in Rural Clinics.

Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents despite the availability of effective screening methods. Outreach activities can improve CRC screening rates but rely on accurate identification of patients due for screening. We report on data challenges in rural clinics and Medicaid health plans in Oregon in identifying patients eligible for CRC screening, in a large project implementing mailed fecal immunochemical tests (FIT) and patient navigation. We analyzed data from clinic intake surveys and administrative claims. Clinics were asked to identify total population numbers relevant to CRC screening and follow-up. Health plans also identified enrollees eligible for CRC screening in Spring, 2021. Clinic staff validated patient lists for eligibility using their electronic health records (EHR). EHR features varied across the 29 participating and 28 responding clinics. Among the 28 responding clinics, 21 were able to report their Medicaid population (75%), 19 reported the number of patients aged 50 to 75 (68%) and the number screened for CRC in the last year (68%). Only 8 (29%) were able to report screening details such as number screened by FIT and 9 were able to report on patients with an abnormal FIT or colonoscopy completed after FIT (32%). Health plans had challenges properly identifying where enrollees received care and had missing data for race and ethnicity (range 22 to 34% unknown race, <1% to 24% unknown ethnicity). Most participating rural primary care clinics and Medicaid health plans experienced challenges identifying the population due for a CRC screening outreach program. Better EHR functionality and data reporting capabilities could help rural clinics apply population-based strategies and ultimately attenuate disparities in cancer screening and follow-up.

Patient self-reported follow-up for radiation oncology patients during COVID-19: feasibility and patient-clinician agreement

Introduction COVID-19 required health services to be innovative and quickly adapt their health service delivery, including adopting health technology in cancer clinical practice. COVID-19 restrictions forced us to introduce follow-up consultations for many patients via telehealth. At the same time, we adapted an existing Patient Reported Outcome messaging service that linked to the patient’s medical record to allow patients to self-report their health and disease status before their telehealth follow-up consultation. This study aimed to evaluate the feasibility of self-reporting for cancer follow-up care, and determine the patient-clinician level of agreement.&#x0D; Methods Cross-sectional clinical practice study. Patients on radiation oncology follow-up care were sent a text message with a weblink to a survey to self-report their health before their radiation oncologist appointment. Radiation oncologists completed the same set of questions during or within a day of the telehealth follow-up consultation. Descriptive statistics were analysed to evaluate the uptake of self-reporting. Percent agreement and Cohen’s Kappa were used to determine patient-clinician agreement.&#x0D; Results A moderate response rate of 62% was achieved from the 145 patients. There was no difference in the age of patients that were able to complete the assessment. Percent agreement between the patient-reported and the clinician-reported for weight change, appetite, physical performance, side effects was acceptable (&gt;75%). However, percent agreement was moderate for pain and sleep. For most items, Cohen’s Kappa indicated moderate agreement, with pain, side effects, and recurrence being fair. Patients were more likely to report themselves worse than the clinician for all items, except for side effects.&#x0D; Conclusion Patient self-reported health can provide useful information for clinicians to remotely follow-up their patients. This holds promise for future models of follow-up care, particularly for rural and remote patients, and during pandemics and other disasters where clinic attendance is not possible.

Prostate cancer, chronic myelogenous leukemia and multiple myeloma in a single patient: a case report and review of the literature

BackgroundSynchronous or metachronous multiple primary malignancies (MPMs) are a known phenomenon. These occurrences may be spontaneous or related to environmental risk factors or genetic predisposition. Chronic myelogenous leukemia (CML) and Multiple myeloma (MM) are two uncommon hematologic malignancies, arises from two different cell lineage. The coexistence of CML and MM that is a rare phenomenon, with only 29 cases reported in the literature. To the best of our, this combination of triple primary cancers has not been reported in a single patient.Case presentationHerein, we reported a case of an 85-year-old Iranian male with three confirmed primary malignant neoplasms. The patient presented with synchronous prostate cancer and CML, in august 2016. He received imatinib and nilotinib for CML and hormonal therapy for prostate cancer. He remained in good control at further follow-ups for about 5 years. In the follow-up period and after 61 months treatment with tyrosine kinase inhibitors (TKIs), CML was undetectable in molecular tests, but the presence of serum M-protein, abnormal plasma cells in the bone marrow, and CRAB criteria was compatible with MM.ConclusionWe must evaluate the possibility of multiple primary cancers during cancer treatment and follow-up and it may be worthwhile to monitor serum electrophoresis and protein levels in TKIs-treated patients.

Local recurrence of breast cancer after mastectomy. Impact of residual tissue in cancer follow-up.

Local recurrence of breast cancer after mastectomy. Impact of residual tissue in cancer follow-up.

The role of procalcitonin in the follow-up of medullary thyroid cancer.

Calcitonin (Ct) represents the most important biochemical marker of medullary thyroid cancer (MTC), but has certain limits. We analyzed the performance of procalcitonin (ProCt) in follow-up MTC patients. In this monocentric and retrospective study, we consecutively obtained ProCt and Ct values from all MTC patients that we visited during the period from April 2021 to May 2022. Patients were defined as having structural evidence of disease (29/90, 32.2%) irrespective of Ct values or, in its absence, as not evident disease (NED) if Ct was ≤10 ng/L (47/90, 52.2%), or minimal residual disease if Ct was >10 ng/L (14/90, 15.6%). Ct and ProCt values were highly correlated (r = 0.883, P < 0.01). Median ProCt values differed between NED, minimal residual disease, and structural disease, being 0.04 ng/mL, 0.26 ng/mL, and 1.98 ng/mL, respectively (P < 0.01). ProCt was undetectable (<0.04 ng/mL) in 40/47 (85.1%) of NED patients, in 3/14 (21.4%) patients with minimal residual disease and in none of the patients with a structural disease (P < 0.01). Among the 11 patients with detectable but ≤10 ng/L Ct and undetectable ProCt values, none had a structural disease. The most accurate cut-off of ProCt to distinguish between the presence or absence of a structural disease was >0.12 ng/mL (P < 0.01, area under the curve: 0.963), with the following sensitivity, specificity, positive predictive value, and negative predictive value (NPV): 100%, 83.61%, 74.4%, and 100.0%. ProCt and Ct have a high correlation in MTC follow-up. ProCt may be useful as an adjunct to Ct, especially for its NPV concerning the structural disease.

Patient-Friendly Summary of the ACR Appropriateness Criteria®: Pretreatment Evaluation and Follow-Up of Endometrial Cancer.

Patient-Friendly Summary of the ACR Appropriateness Criteria®: Pretreatment Evaluation and Follow-Up of Endometrial Cancer.

Immuno-analytical characteristics of PSA and derived biomarkers (total PSA, free PSA, p2PSA)

Prostate-specific antigen (PSA) is the recommended tumor marker for individual screening and follow-up of prostate cancer. This paper reviews main structural and physiological data about prostate specific antigen isoforms: total PSA, free PSA, [-2]proPSA (also named p2PSA). It describes the pre-, per- and post-analytical conditions for these different parameters. It presents the interpretation of results and derived calculated indices (free/total PSA ratio, Prostate Health Index or PHI) for the management of prostate cancer (initial diagnosis and follow-up).

Predictive value of highly sensitive basal versus stimulated thyroglobulin measurement in long-term follow-up of thyroid cancer.

Recurrence of differentiated thyroid cancer (DTC) is associated with reduced quality of life, and therefore, early identification of patients at risk is urgently needed.Here we investigated the predictive power of various cut-off values of single stimulated thyroglobulin (s-Tg) and single highly sensitive measured, unstimulated thyroglobulin (u-hsTg) measurements close to the end of primary therapy for recurrence-free survival (RFS) in long-term follow-up (>10 years) of patients with DTC. In DTC patients with adjuvant radioiodine therapy, we assessed retrospectively u-hsTg (6 ± 3 months before s-Tg measurement) and s-Tg measurements (≤24 months after last radioiodine therapy). Positive predictive (PPV)/negative predictive values (NPV) of various cut-off values (s-Tg: 0.5/1.0 ng/mL; u-hsTg: 0.09/0.2 ng/mL) for patient outcomes as well as additional factors associated with disease development were analyzed. In total, 175 patients were retrospectively reviewed (tumor recurrence: n = 14/complete remission: n = 161). Examined cut-off values for s-Tg and u-hsTg showed significant predictive power for RFS (log-rank: all P < 0.001). NPV/PPV for s-Tg were 98.6%/36.4%, respectively (0.5 ng/mL cut-off) and 96.7%/42.9%, respectively (1.0 ng/mL cut-off); those for u-hsTg were 97.3%/35.7%, respectively (0.09 ng/mL cut-off) and 95.2%/85.7%, respectively (0.2 ng/mL cut-off). U-hsTg (P < 0.001) and patient age (P < 0.05) were significantly associated with tumor recurrence. One-third of patients with tumor recurrence in the course initially showed undetectable u-hsTg after completion of primary therapy. With >10 years of follow-up, both s-Tg and u-hsTg have a comparably high predictive power for RFS, while only u-hsTg was significantly associated with a recurrence event.Serial u-hsTg measurements seem warranted since patients with tumor recurrence during follow-up may have an undetectable tumor marker at baseline.